First Aid Management For Sepsis

ANZCOR makes the following recommendations in summary for First Aid Management of the Seriously Ill person including Sepsis.

This downloadable guideline aims to help the first aider recognise the person in need of urgent medical care but is not intended for the diagnosis of illnesses. 

1. First aid responders need to learn how to recognise a seriously ill person.

2. If a serious illness is suspected, send for an ambulance. Delayed treatment can quickly lead to more severe illness and result in death from systemic organ failure.

Many conditions present in the community that need urgent assessment and treatment by health care professionals. Most of them are obvious, but some are difficult to diagnose even under ideal circumstances in a hospital.

One frequent example is sepsis. Several other conditions are hard to distinguish from sepsis. However, the diagnosis of the exact condition is not important for the first aider because these conditions share a common set of symptoms and signs. It is more important to recognise that a person needs urgent medical care than to diagnose the nature of the illness.

There is very little published about the first aid management or recognition of these conditions. There is a growing body of evidence about how health care professionals should “recognise the deteriorating patient.”

What Is Sepsis

‘Sepsis is an illness that can happen in response to an infection and can quickly become life-threatening. It can affect all parts of the body. In severe cases of sepsis, one or more organs fail. In the worst cases (known as septic shock), sepsis causes the blood pressure to decrease to dangerous levels and the heart to become weaker. Once this happens, multiple organs may fail quickly and, if not corrected, the patient will die’.

Sepsis is a medical emergency that can be difficult to diagnose and treat. More information on sepsis can be found on the Australian Sepsis Network website.

Anyone can deteriorate quickly with a serious illness, but certain people are at higher risk, including:

• Children under 1

• People over 65 years of age

• People with chronic diseases

• People with weakened immune systems

• Aboriginal and Torres Strait Islander Peoples, Māori and Pasifika cultures.

Recognition Of Serious Illness

Early recognition of serious illness is critical as early treatment improves outcomes. These symptoms and signs set out below may indicate serious illness. These symptoms and signs are common to many conditions, and it is their combination that alerts health professionals to the possibility of serious illness and prompts further investigation and treatment.

The more signs and symptoms in combination, the higher the risk that the underlying problem is a serious illness. Perhaps the most important indicator is that the person with a serious illness feels “not right” or say they might feel they are “going to die”. This is even more significant if the people that know this person have noticed a change in their behaviour.

Serious Illness Identification Red Flags

The greater number of red flags present, the greater the concern that the person is seriously ill.     The bulk of the evidence related to serious illness in adults is from in-hospital studies, so the indicators of serious illness in adults are extrapolated from that evidence. The indicators of serious illness in adults include:

• Rapid breathing (breathing rate greater than 22 breathes per minute) is the most reliable indicator of serious illness in adults

• Breathlessness or feeling short of breath

• Restlessness, agitation, dizziness, decreased level of consciousness, confusion, slurred speech, or disorientation

•Uncontrollable shivering or shaking, fever or feeling very cold

• Unexplained muscle pain or discomfort

• Passing little or no urine

• Rapid heart rate

• Nausea and or vomiting

• New rash or blotchy, pale, or discoloured (often described as mottled) skin

• The person may say they ‘don’t feel right’, or they might say they feel like they ‘are going to die’.

Serious Illness In Children And Infants

Children and infants with a serious illness can deteriorate extremely quickly. Symptoms and signs of serious illness in infants and children may include:

• Rapid breathing, weak cry, or grunting

• Hard to wake, lethargic or floppy

• Seizure or fits

• A rash that doesn’t fade when pressed

• Discoloured, mottled, very pale or bluish skin

• Fever, feeling cold or cold to touch

• Vomiting repeatedly

• Not passing urine (or no wet nappy) for several hours

• Not feeding or drinking.

Children often cannot express how they feel, so look for the combination of an infection with any of the signs and symptoms listed. In children, parental concern that this illness is more severe or different and care providers thinking “something is wrong” are predictive of the presence of sepsis.

Management Of A Serious Illness

A serious illness is a medical emergency and typically requires in-hospital management and the prompt administration of medications or an operation that targets the infection or other illness.

Send for an ambulance by calling 000 if:

• You suspect sepsis or other serious illness

• An infection-related illness is not improving

• Carer is concerned that this illness is more severe or different

• Care providers (including first aiders) think “something is wrong.”

For unresponsive, unconscious, or having seizures, send for an ambulance

• If the person is unresponsive and not breathing normally, commence resuscitation following the

Basic Life Support DRSABCD protocols.

• If the person is unconscious but breathing, lie them on their side in the recovery position, ensure the airway is clear, and keep them under observation.

• If the person is having a seizure, lie them on their side, ensure the airway is clear and keep them under observation.

• Administer oxygen only if there are obvious signs of shock or evidence of low oxygen saturation according to the use of Oxygen in Emergencies protocols.

Those That Are Conscious

Send for an ambulance.

• Lie the person down if comfortable lying down.

• Treat for shock if present, but do not cover with a blanket if the person already feels hot to the touch.

• Consider administering oxygen if indicated and you are trained in oxygen therapy, and the equipment is accessible.

• Reassure and constantly re-check the person’s condition for any changes.

What Is Septic Shock

Septic shock is a condition in which the blood pressure falls. The body’s organs fail to receive sufficient oxygen to function, causing a systemic system shutdown and multiple organ failures that can result in death.

Bacterial infections are the most common causes of sepsis. They can originate externally in cuts or wounds that become infected or due to conditions such as pneumonia. Most people make a full recovery from sepsis. But it can take time.

Sepsis can be prevented easily in external cases by applying antibacterial medications to cuts, scrapes, and open wounds and then covering them until they heal, checking daily to re-treat and change dressings, or ensuring the wound site is clean and healing without infection.